Interventions Targeting Social and Vocational Dysfunction in Individuals with a Schizophrenia Spectrum Disorder

  • Cali F. BartholomeuszEmail author
  • Eóin Killackey
  • Andrew Thompson
  • Stephen J. Wood


Individuals with a schizophrenia spectrum disorder are among the most marginalized of any chronic illness group, having poorer performance and outcomes in nearly every domain of health and functioning. Poor social functioning is now widely acknowledged to be a major indicator of the prognosis of schizophrenia as well as a major contributor to illness outcome. Social and functional disabilities have serious detrimental effects on the individuals’ quality of life and recovery, yet up until the twenty-first century treatment had largely been concentrated around symptomatic improvement, with the assumption that functional recovery would automatically follow. However, statistics on functional outcomes for individuals with schizophrenia and other psychotic illnesses suggest that this is in fact a relatively rare phenomenon. The definitions of “functioning” and “outcome” have also been poorly defined and inconsistent over the years, with alleviation of psychotic symptoms and decreased hospital admissions weighing heavily in the characterisation of improved functional outcome. In the last decade most studies have included a general measure of global functioning and/or education/employment as an indicator, but these performance measures have generally not been the primary topic of interest. Only recently has the incorporation of “social” functioning (i.e. social competence, independent living, community involvement and interpersonal relationships), been included as an important factor in overall outcome and moved into the spotlight as a major target for intervention. Historically, social skills training and cognitive remediation have been used to target deficits in social behaviour and cognition, respectively. However, new intervention strategies are being designed to target the underlying thinking patterns related to social interaction, termed social cognition. This chapter will review the different types of interventions that have been or are currently used to treat social and occupational dysfunction in schizophrenia spectrum illnesses, and assess their effectiveness in terms of the immediate and longitudinal outcome.


Illness outcome Functional disability Social functioning Vocational intervention Social cognition training Early intervention 



Anterior cingulate cortex


Cognitive adaptation training


Cognitive behavioural therapy


Cognitive enhancement therapy


Clinical global impression of cognition in schizophrenia


Cognitive remediation training


Emotion management training


Emotional intelligence/emotional quotient


Enriched supportive therapy


First episode psychosis


Global assessment of functioning


Health of the nation outcome scale


International Center for Clubhouse Development


Individual placement and support


Measurement and treatment research to improve cognition in schizophrenia


Metacognitive skills training


Ekman’s micro-expression training tool


Medial prefrontal cortex


Magnetic resonance imaging


Neurocognitive enhancement therapy


National Institute of Mental Health


Picture arrangement


Program of assertive community treatment


Pictures of facial affect


Heinrichs-Carpenter quality of life scale


Randomised controlled trials


Social behaviour schedule


Social cognition enhancement training


Social cognition and interaction training


36 item short-form health survey


Social and occupational functioning assessment scale


Schizophrenia outpatients health outcomes


Scottish schizophrenia outcomes study


Social skills training


Superior temporal sulcus


Training of affect recognition


Treatment as usual


Theory of mind


University of California at San Diego


Ultra high-risk for psychosis


UCSD performance-based skills assessment


Work therapy



We would like to acknowledge the National Health and Medical Research Council of Australia for fellowship funding awarded to Dr Bartholomeusz.


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Cali F. Bartholomeusz
    • 1
    Email author
  • Eóin Killackey
    • 2
  • Andrew Thompson
    • 3
  • Stephen J. Wood
    • 4
    • 5
  1. 1.Department of PsychiatryMelbourne Neuropsychiatry Centre, The University of MelbourneMelbourneAustralia
  2. 2.Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of MelbourneMelbourneAustralia
  3. 3.Orygen Youth Health, Melbourne Health, North Western Mental HealthMelbourneAustralia
  4. 4.University of BirminghamBirminghamUK
  5. 5.Department of PsychiatryMelbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne HealthMelbourneAustralia

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